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Rhode Island rates for HCPCS L0642

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.72 / $211.21 / $298.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$619.02 / $687.80 / $993.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.21 / $264.83 / $343.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $301.51 / $301.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.10 / $301.51 / $301.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.18 / $257.58 / $401.95